In November of 2013, Medicare changed the ‘homebound’ policy ever so slightly. It seems that the changes were significant that they are now causing denials now that the Face-to-Face documentation denial is on the way out.
To be certain, patients who were homebound prior to the change will still be considered homebound. The difference is in documentation. Here’s how it now works.
The patient must fall into one of the two following categories:
- Because of illness or injury, need the aid of supportive devices such as crutches, canes, wheelchairs, and walkers; the use of special transportation; or the assistance of another person in order to leave their place of residence
- Have a condition such that leaving his or her home is medically contraindicated
Nothing new there, right?
If your patient falls into the first category, documentation of the supportive devices, canes, special transportation, etc. will no longer suffice to establish your patient as confined to the home. When a patient is homebound due to an illness or injury causing the patient to need assist devices and transportation, the following must also be documented:
There must exist a normal inability to leave home; AND Leaving home must require a considerable and taxing effort.
Some of you think that because your patient is without legs and cannot see and never leaves the house unless his two brothers lift him into a specially equipped van that you have established homebound status. You couldn’t be more wrong.
After documenting all of that, you cannot expect the reviewers at Palmetto to deduce from your description that it was a taxing effort and that this was a ‘normal’ inability to leave the home.
I know a lot of you will blow me off as you usually do thinking I am going overboard again. That’s okay. Call me when you are denied and I will write your appeals for you. For a price.
When it comes to paying bills, Medicare is just saying no.
For those of you who are regular clients and others who want a taste of what it is like having cancer and such, read Lisa’s page. Lisa is a friend who became ill with cancer and then tragically lost the man she had lived with for eight years a couple of weeks ago. So, I am staying with her for a while in Florida. It has been eye-opening seeing how that whole healthcare thing works from the patient/family perspective. It’s also been a lot of fun. Advice is always welcome. Here’s your chance to be the consultant’s consultant.